Clinical manifestations

The most common presenting symptoms of acute sinusitis are a persistent "cold" with coryza and postnasal drip. Headache and fever are also frequently seen. The patient may complain of local pain and the examination will often show tenderness over the affected sinus(es). The frontal and maxillary sinuses can be palpated directly. The ethmoids can be evaluated by pinching the bridge of the nose. The sphenoid is the hardest sinus to evaluate on physical examination because of its inaccessible posterior location. Examination of the inside of the nose may show pus emerging from one or more turbinates. Another clue is "double sickening"; this refers to patients who start with a cold and begin to improve, only to have the congestion and discomfort return.

Transillumination can help in the diagnosis of sinusitis. It is necessary to have experience with the technique, a dark viewing area, and a strong light. The failure to transilluminate

a frontal or maxillary sinus is supportive evidence for the finding of a fluid-filled sinus by radiographic techniques.

In children, the symptoms of sinusitis are less specific

than in adults. Symptoms include persistent nasal congestion and cough lasting for more than 10 days, high fever and purulent nasal discharge. Children are less likely to present with facial pain or headache.

The differential diagnosis of acute sinusitis includes protracted upper respiratory infection, dental disease, nasal foreign body, migraine or cluster headache, temporal arteritis, tension headache and temporomandibular disorders.